中文摘要：

目的 总结Ilizarov技术矫治马蹄足畸形中发生胫距关节前脱位的概率、治疗及预防方法.方法 回顾性分析2011年10月至2012年4月,应用Ilizarov技术矫治38例马蹄足畸形患者资料,其中5例于术后14～ 28 d发生胫距关节前脱位,男4例,女1例;年龄19 ～ 30岁,平均23.8岁;均为马蹄内翻足畸形患者.5例患者初次手术采用Ilizarov技术矫治马蹄足畸形,同时行经皮跟腱延长术、经皮跖腱膜切断术、胫后肌松解、胫前肌移位,其中4例同期行距骨周围截骨术,1例同期行第一跖骨基底截骨术,1例同期行胫骨近端去旋转截骨术;发生胫距关节前脱位后,1例经手法复位,4例使用Ilizarov复位装置后继续按原计划牵伸调整外固定架矫形,直至满意.结果 5例马蹄内翻足畸形患者在行Ilizarov技术矫形过程中发生胫距关节前脱位的概率为13.2％ （5/38）.5例患者均获得随访,随访时间6～ 12个月,平均10个月,马蹄足畸形均完全矫正.末次随访时应用国际马蹄足畸形研究学组评分为3～10分,平均4.8分;其中优2例,良3例,优良率为100％.无一例发生钉道感染、神经血管损伤、血栓等并发症.结论 胫距关节脱位是Ilizarov技术矫治马蹄足畸形中较常见的并发症,发生率约为13％.发生胫距关节前脱位后,及时安装距骨复位装置可获得良好效果.围手术期管理应注意外固定铰链关节与踝关节瞬时旋转中心的匹配.

英文摘要：

Objective To observe the occurrence of tibiotalar anterior dislocation in the correction of equinus deformity using Ilizarov technology,and summarize the strategy of prevention and treatment for tibiotalar anterior dislocation.Methods Thirty-eight patients of equinus deformity,admitted from October 2011 to April 2012,had been treated by the Ilizarov technology.Tibiotalar dislocation happened on 5 equinovarus deformity cases 4-18 days after operation,including 4 males and 1 female,with an average age of 23.8 years old （range,19-30 years old）.Ilizarov technology were performed in these 5 cases for the primary surgery,Meanwhile,Achilles tendon percutaneous lengthening,the plantar fascia percutaneous cutting,tibialis posterior loosing and tibialis anterior transporting were also performed.Among them,4 cases were treated with osteotomy around the talus,1 case with the first metatarsal osteotomy,1 case with de-rotation osteotomy in proximal tibia.All the surgeries were accomplished by the same medical group with the standard procedures.When tibiotalar anterior dislocation occurred,the Ilizarov reset device had been installed near the tibiotalar joint of the patients.The original distraction plans were kept on going until the satisfied correction of equinus deformity was observed.Results Five cases were suffered from talus anterior dislocation,accounting for 13.2％ in all （5/38）.All the 5 cases were followed up from 6 to12 months,with an average time of 10 months.At the latest follow-up,all patients were corrected completely.According to the score of International Clubfoot Study Group （ICFSG）,the cases were scaled from 3 to 10 scores （averaged 4.8 scores）.Two cases were ranked as excellent,3 cases as good.No obvious complications happened,such as pin site infections,nerve and vessel injuries and thrombus.Conclusion Tibiotalar anterior dislocation is a common complication in the correction of equinus deformity using Ilizarov technology,accounting for 13％.Good effect can be acquired when the Ilizarov re